Appealing a Georgia Workers Compensation Denial

Understand what steps should be taken when appealing a workers compensation denial in the state of Georgia.

If you are injured while working in Georgia, you likely have a valid workers’ compensation claim. Workers’ compensation is a system designed to provide benefits to injured workers in the state. (For more information, see our article on workers' comp basics in Georgia.)

Claim Denial

If you do not begin receiving any workers’ compensation benefits, such as replacement wages for time off work, or reimbursement for your medical expenses, your employer or its insurance company most likely denied your workers' comp claim. You may request a hearing before the State Board of Workers’ Compensation to appeal the denial of your workers’ compensation claim.

You may represent yourself, or you may have an attorney represent you. Representing yourself is not a simple matter, as the hearing process is a complex legal process with specific requirements for court procedures.

The board can provide you with the paperwork required to obtain a hearing. Once you have completed the paperwork, send a copy to your employer and its workers’ compensation insurance carrier, and send the completed forms to the board. You will then be assigned a judge and a hearing date.

Mediation

In many cases, you will be required to go through mediation prior to your hearing. Mediation is a process through which a mediator meets with you and your employer or its insurance company in an attempt to resolve the dispute. You, your attorney (if you have one), your employer, and your employer’s representative, will meet with the mediator.

Mediation is much more informal than a hearing (which is more like a trial). You will be given the opportunity to present your position and explain what benefits you believe you are entitled to. Anything you share during mediation is confidential, meaning it cannot be used in any subsequent court proceedings.

The mediator will help facilitate the discussion, but the mediator will not issue a binding decision. If your and your employer are unable to reach an agreement, the case will return to the judge for a hearing.

Hearing

If the parties cannot reach a solution during mediation or other settlement negotiations, the matter will proceed to hearing before the judge. A hearing is like a trial, with all of the rules of procedure and rules of evidence involved. The hearing will take place in or near the county where your workplace injury or occupational disease occurred.

During the hearing, you will have an opportunity to present evidence to prove that you are owed workers’ compensation benefits. You must provide evidence to support your position. Note that you must present live witness testimony, not letters or other statements, as these are not admissible in the hearing. You should plan to have your doctor(s) testify so that you can present sufficient medical evidence to support existence of your injury and causality of your injury. You may also bring eyewitnesses to your injury and ask questions of your employer’s witnesses.

The judge will review all of the admissible evidence presented. The judge will then issue a written decision regarding what benefits, if any, you should receive.

Appeals to the Appellate Division

If you disagree with the judge’s decision, you may appeal, within twenty days of the decision, to the Appellate Division of the State Board of Workers' Compensation. The Appellate Division will review your case and issue a written decision.

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